| NPI | 1306109673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0102203552) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0102203552) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-03-23 |